Baroness Claire Tyler of Enfield in the House of Lords

Month: December 2016

Yesterday I made a speech in the House of Lords on Social Mobility. Below is a short extract. You can find my speech in full here.

Just over 18 months ago I proposed The Lords Select Committee on Social Mobility. It published its report in April this year, entitled “Overlooked and left behind: improving the transition from school to work for the majority of young people”. I believe this title still says it all. Those young people not pursuing either higher education or apprenticeships – that is, just under half of them – face a system beset by a lack of funding, esteem, guidance and co-ordination. The current system isn’t just unfair on the individual young person, often leading to a life time of missed opportunities. It also damages the UK’s economy and limits our collective human capital. Investing in our young people today has significant long-term economic and social value tomorrow, but only if we get the system right for all.

On Tuesday, I made a speech in the Lords lamenting the lack of progress in achieving parity of esteem between mental and physical health. I called on the Government to address the underfunding of mental health services and the underlying cultural issues that lie at the heart of the problem.

I asked the Government why in the Autumn Statement there was funding for the expansion of grammar schools but not a penny for the NHS. I await their reply with interest.

The fundamental question for us is why it has been so difficult to achieve real and sustained progress. I did a quick survey of the scene, and many aspects I did not find very reassuring. As Michael Marmot so powerfully reminded us in his recent book The Health Gap: The Challenge of an Unequal World, people with mental ill health have a life expectancy between 10 and 20 years shorter than people with no mental illness. I am sure we all find that shocking.

Only a quarter of those with mental illness such as depression are receiving treatment, a figure that contrasts with 78% of those with heart disease and 91% of those with high blood pressure. A recent CQC report noted that, when facing a crisis, a shocking 32% of people do not know who to contact out of hours. Indeed, 24% of those who did know said they did not receive the care they needed.

As we have already heard, last year, across the board, 40% of NHS mental health providers had their funding reduced, despite NHS England instructing commissioners to increase it. This raises serious questions as to whether funding is reaching the areas where it is most needed, and it highlights the damaging impact of the Government’s refusal to ring-fence mental health funding. I know Jeremy Hunt said that he does not have the power to do that, but frankly, Governments, if they are so minded, can do something about it if they do not have the powers.

It is the same story with the £1 billion announced last year for mental health, much of which does not come on stream until the end of this Parliament. One could be forgiven for assuming that in last week’s Autumn Statement, the Chancellor would have offered a lifeline to mental health services, as well as other areas of health and social care. Instead, the Government found £240 million for the expansion of grammar schools, but not a penny for the NHS.

Last week, the Government announced plans to begin pilots to extend the current physical health assessments to cover mental health for children entering care. In the last few months I have been fighting for this amendment and am delighted that following discussions with Ministers at the Department of Education this important change will go ahead.

I made a speech thanking the Minister for the Government’s response and welcoming the introduction of the pilots. You can find my speech in full here.

I recently wrote an article for the Liberal Democrat Voice regarding the success of this campaign – the article is available here.

I am very encouraged by and was grateful to hear the commitment that he made today at the Dispatch Box, announcing that there will be, I think he said, between six and 10 pilots starting in April or May next year, to test out new approaches to mental health assessments for children in care. As he said, this will happen in parallel to the valuable and important work of the expert working group. I consider this to be a really important step forward, so I am very grateful to him and I look forward to making any contribution that I can to the development and implementation of these pilots. I thank him and all noble Lords who have participated in this discussion and I will say again how pleased I am by this progress. I beg leave to withdraw the amendment.

On the 16th of November, I asked for the Government’s response to the Values-Based Child and Adolescent Mental Health System Commission ‘What Really Matters in Children and Young People’s Mental Health’.

I called on Government to recognise a key recommendation of the report, that schools if properly funded and supported, have the potential to make a really big difference to improving children’s mental health.

My amendment is designed to ensure that we can achieve some practical improvements to the care that children receive. It introduces mechanisms that will ensure that the mental health needs of children entering care are properly assessed and that they have access to specialist support if this is needed. Basically, the amendment has two elements: first, a mental health assessment for children entering care, carried out by a qualified professional; and, secondly, a designated health professional in each local authority who has strategic oversight of the outcomes of the assessments and matches those with the services that are available for children in care to support their needs.

In short, this amendment seeks to establish a mechanism that will identify children’s needs early on, refer the children to the right services and ensure that services exist that children in care are able to access—and access easily. This joined-up approach is supported by the Alliance for Children in Care, a coalition of leading children’s charities, as well as the Royal College of Nursing, the Royal College of Paediatrics and Child Health, and the Royal College of Psychiatrists.

On the 17th of October, I made a speech in the Lords about the shocking statistics concerning premature deaths of people with learning difficulties. I called for mandatory participation in learning disability mortality review.

We have already heard, from the noble Baroness, Lady Rawlings, the shocking statistics that men with learning disabilities die, on average, 13 years sooner than men in the general public and women with learning disabilities die 20 years sooner. Overall, 22% of those people were under 50 when they died. These are not just dry statistics, they are deeply shocking and nothing short of a national disgrace. Perhaps the most shocking statistic of all is the confidential inquiry’s finding that 37% of deaths were potentially avoidable if good quality healthcare had been provided.

As we have already heard from the confidential inquiry, one of the 18 key recommendations was the establishment of a national learning disability mortality review. A key part of the review programme, commissioned again by NHS England, is to support local areas to review the deaths of people with learning disabilities and take forward the lessons learned to improve services. I am sure we all think that is what should happen. So far, so good. However, as has already been referred to by the noble Baroness, Lady Hollins, participation in the programme is not mandatory, so, unlike the child death review process, and, indeed, many other inquiries, agencies can choose whether or not to contribute to the review of deaths of people with learning disabilities. In the current financial climate, I guess it is understandable that many organisations choose to do only what they have to. In my view, giving this issue mandatory status would undoubtedly raise the profile of the work and show that the lives and deaths of people with learning disabilities are valued. That is the crux of what we are talking about tonight.

On the 8th of September, I made a speech in the Lords underlining the impact of the 2012 Act on health and social care. I noted that there is simply not enough money to do all the things asked of the health and social care system at a time of rising demand from a growing and ageing population.

As we have heard, the 2012 Act introduced major structural changes—I am not going to run through them again—but how has the system responded to these changes in the face of huge financial and operational pressures? To answer that question it is important to highlight some key factors. First, whatever their rights and wrongs, the geography of clinical commissioning groups is not strategic. Simply put, there are considerably more CCGs—some 209—than there are hospitals, of which there are just over 150. That is not helpful. Such fragmentation militates against strategic planning and decision-making.

The simple truth is that there is not enough money in the system to do all the things being asked of the health and social care system at a time of rapidly rising demand from a growing and ageing population—and that is before we come to the newest policy goal of seven-day working. We would all like to see that in an ideal world, but it must be properly resourced and planned if it is ever to become a reality. The current approach of trying to ram it through on resources that are not really adequate for five-day working, let alone seven, is clearly not viable.

On the 21st of July, I made a speech in the Lords calling on the Government to clarify urgently the status of EU nationals working in health and social care in the UK. I also underlined how important it is that NHS providers retain the ability to recruit staff from the EU.

As we have heard in the debate, the UK’s vote to leave the EU will without doubt have major implications for health and social care, not least because it has ushered in a period of major economic and political uncertainty at a time when the health and care system faces huge operational and financial pressures, as we have debated so many times in this Chamber. The NHS faces an extremely challenging set of circumstances. Demand, particularly from our ageing population, continues to grow faster than funding, putting further pressure on an already strained service. Fundamental change in how we provide care is urgently needed if the NHS is to be successful in meeting the twin challenges of providing high-quality services while balancing the books. To do this it is vital that we have the right numbers of staff with the right skills in the right place, and ensure that they feel valued, welcome and engaged in the work that they do—hence the debate we are having this afternoon.

I end by raising an issue that the noble Lord, Lord Bilimoria, also mentioned. It is about that lie—that most flagrant and disgraceful lie—of the leave campaign. I have to say that there was very stiff competition for that particular accolade, but it is the lie where we were told that £350 million extra per week would be available for the NHS—it was plastered all over the campaign buses. Then of course it was retracted, even before the ink was dry on the results. But the public, quite understandably, now have an expectation that NHS spending will rise after the UK leaves the EU. I have never been very good at maths but I just made a little calculation. It is four weeks now—to the day, I think—since the referendum, so my calculation tells me that, four weeks on, £1.4 billion is now owed to the NHS. Can the Minister tell us whether that money has yet been received and, if not, how quickly he expects that money to be in the Department of Health coffers?

On the 13th of July, I made a speech in the Lords expressing my concerns regarding the setting up of a new regulator. I, along with many others, voiced concerns about the high drop-out rates and increased workloads of social workers.

I was taken with the report that I saw on the BBC this morning about the Commons Education Committee which said that urgent action is needed regarding social workers’ case loads. It drew attention to high drop-out rates leading to increased workloads. It said that these problems must be tackled, particularly the endemic retention problems in the profession. These are the issues that are crying out for urgent attention, and that is my first concern about diverting our attention from them.

On July the 6th, I made a speech in the Lords calling for children in care to have more sibling contact. This is important as children who have regular contact with their siblings tend to do better in terms of outcomes.

It is absolutely the case that relationships with siblings are often the most enduring that those children have. Indeed, as we have just heard from the noble Lord, Lord Warner, they can be as important to children as the relationship with their parents, particularly if they have supported each other through difficult times.